Understanding Eating Disorders

Eating disorders (ED) are not physical, but psychiatric illnesses. Eating disorders can be driven by social factors such as the media’s ad depictions of beauty.

These disorders can also be driven by our environmental exposure as well. Environmental factors include bullying, OCD, depression, and other life stressors.

Of all of the mental health disorders, ED’s have the highest mortality rate.

Our culture seems to be inundated by messages regarding images of beauty, fear of obesity, and debates about diets and exercise. With this in mind, there is no wonder more than 30 million people suffer from an eating disorder.

When thinking of people with ED’s you may conjure an image of a healthy, young person who develops anorexia or bulimia as their life spins out of control. The truth is, sometimes ED’s don’t manifest until someone becomes elderly or ill.

In my current job, I have had many cases of elderly anorexic patients, who refuse food and have to be hospitalized for medical treatment. In some of these cases, feeding tubes are surgically implanted to provide nutrition.

Anorexia

Anorexia affects men and women alike. It typically presents in adolescence but could occur at any age.

Anorexia Nervosa manifests as a persistent fear of weight gain; restricted caloric/energy intake; behaviors and/or actions that assist in limiting weight gain. They are in a constant state of semi-starvation. Those with anorexia nervosa have significant weight loss, fail to gain or maintain weight.

People with anorexia typically do not recognize the dangers of their severe weight loss or frailness. They may verbally acknowledge being thin, but also have a warped view of their physical body and believe that there is body fat or weight to be lost.

Other psychiatric diagnoses may be observed in those with anorexia nervosa such as depression and obsessive-compulsive behaviors.

Other symptoms could include:

irritability

social withdraw

weakness

dental decay

insomnia

loss of interest in activities previously enjoyed

refusal to eat around others

misuse of medication

excessive exercising

Upon closer clinical assessment, low blood pressure, low temperature and a slow heart rate are common as the body’s metabolic rate decreases. As the disease progresses, the skin can become thin, yellow and the person may bruise easily.

Bulimia

Bulimia Nervosa manifests as a persistent fear of weight gain, similar to anorexia nervosa. However, instead of restricting caloric/food intake by refusal or limited eating, those with bulimia eat a large amount of food (binge eating), over a limited amount of time and follow the intake by precisely planned elimination. That elimination could include induced vomiting, laxative or other medication misuse, enemas or excessive exercise to prevent or control weight gain. The cyclical nature of bulimia should be noted.

The sense of loss of control, the binge eating, is followed by the behaviors of control, the elimination. This is why, I think, bulimia is more difficult to notice, at least early on in the disease.

Bulimia typically presents later than anorexia; teens to young adult. Bulimia is diagnosed in women more than men.

Binge-eating

Binge-eating disorder manifests as a feeling of loss of control when eating large amounts of food in a short period of time.

Signs of binge-eating disorder are:

eating when not hungry;

eating alone because of embarrassment over the amount of food ingested;

eating when uncomfortably full;

eating in a short period of time;

feeling depressed or guilty after binge-eating.

Binge-eating can be further described according to the frequency of the binge episodes, as mild (1-3 times/week), moderate (4-7 times/week), severe (8-13 times/week), or extreme (14 or more times per week).

Avoidant/Restrictive Food Intake

Avoidant/Restrictive Food Intake Disorder (ARFID) is a disorder recently added to the DSM and is defined as “An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs…” (https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm10) This disorder is seen more frequently in infants than adults.

Avoidant/restrictive food intake disorder, unlike anorexia and bulimia, are not associated with concerns over body weight or shape. The effect of this disorder on a person’s weight is secondary.

For some, this disorder is associated with the characteristics of food, such as the smell, color or textures of some foods. I have witnessed this often in people with autism, developmental delays and in children who associate food intake with unpleasurable/painful experiences (e.g., choking, frequent vomiting).

Physical conditions associated with this disorder include abdominal pain, nausea, vomiting, loss of appetite, structural disorders of the mouth, and decreased muscle tone.

Pica

Pica occurs when nonfood/ non-nutritive substances are ingested. People with pica can ingest anything from paper, hair barrettes, earrings, cotton balls, or baby powder, just to name a few. As you can see, people with Pica can eat just about anything.

Sometimes this is done unconsciously, as seen in some people with intellectual disabilities.

Pica is also seen, as a secondary diagnosis, in those with anorexia nervosa. The non-nutritive ingestion is used to prevent weight gain.

Pica is most commonly seen in those with schizophrenia, autism, intellectual disabilities and obsessive disorder. If pica is suspected, the individuals should be closely monitored as surgical intervention may be needed depending on the objects ingested (think pins or other sharp objects).

Other associated psychiatric diagnoses such as depression, bipolar disorder, and personality disorders.

Rumination

Rumination Disorder occurs when food is regurgitated. The regurgitated food may be re-swallowed, spit out or re-chewed.

Rumination Disorder is not associated with problems with any medical conditions or nausea. Those with Rumination Disorder exhibit this behavior several times during the week.

I have personally witnessed this disorder in toddlers, as well as school-aged children. This can also manifest in adults. Older individuals with this disorder tend to hide their behavior by avoiding social events, covering their mouth, or covering the behavior with a cough.

Eating disorders not only affect the individual with the disorder, but also the families and friends around them. Addressing the issue and providing the right support can be a challenge, but is absolutely necessary.

NEDA has an online screening disorder tool that for people over the age of 13. It’s simple and easy to use. If you know of someone that could possibly have an eating disorder, give this tool a try.

If you know of any other resources for people with eating disorders, please leave a comment below.

The information in this article is to be used for informational purposes only. It is NOT to be used in place of, or in conjunction with, professional medical advice. Anyone with questions regarding this or other medical issues discussed on this site must consult their physician for further information and treatment.